<?php
$this->registerJsFile('/js/user/store_apply.js?v=1.0.0');
?>

<div class="layui-container bg-white p60 mt60 settle-wrap">

    <form class="layui-form" action="">
        <div class="layui-form-item border-b pb30 f16">
            <span class="info">商家类型：</span><?=$type_name?>
        </div>
        <div class="layui-form-item">
            <h3 class="info-title">公司信息<span class="f12 info ml30">公司信息所提交的资料仅用于您在平台进行认证审核所用，我们会对隐私类资料进行保密。</span></h3>
        </div>

        <div class="layui-form-item">
            <label class="layui-form-label"><span class="red">*</span> 公司名称：</label>
            <div class="layui-input-block">
                <input type="hidden" id="type" value="<?=$type?>"/>
                    <input type="text" name="name" id="name" autocomplete="off" class="layui-input">
                    <p class="info mt f13">请与营业执照名称保持一致。</p>
            </div>
        </div>
        <div class="layui-form-item" id="area-picker">
            <div class="layui-form-label"><span class="red">*</span> 公司地址：</div>
            <div class="layui-input-inline">
                <select name="province" id="province" class="province-selector" data-value="贵州省" lay-filter="province">
                    <option value="">请选择省</option>
                    <?php foreach ($region_1 as $province_region){?>
                    <option value="<?=$province_region['id']?>"><?=$province_region['name']?></option>
                    <?php }?>
                </select>
            </div>
            <div class="layui-input-inline">
                <select name="city" id="city" class="city-selector" data-value="黔西南布依族苗族自治州" lay-filter="city">
                    <option value="">请选择市</option>
                </select>
            </div>
            <div class="layui-input-inline">
                <select name="county" id="county" class="county-selector" data-value="兴义市" lay-filter="county">
                    <option value="">请选择区</option>
                </select>
            </div>
            <div class="layui-input-inline" id="area-remind"></div>
        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"></label>
                <div class="layui-input-block">
                        <input type="text" name="address" id="address" autocomplete="off" placeholder="请输入详细地址" class="layui-input">
                </div>

        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 营业执照注册号：</label>
                <div class="layui-input-block">
                        <input type="text" name="bussiness_no" id="bussiness_no" autocomplete="off" class="layui-input">
                        <p class="info mt f13">请输入15位营业执照注册号或18位统一社会信用代码。</p>
                </div>

        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 营业执照扫描件</label>					
                <div class="layui-input-inline">
                    <div class="layui-upload photo-bak" id="bussiness_img_preview">						  
                          营业执照扫描件
                    </div> 
                </div>				
                <div class="layui-input-inline" style="width: 300px;">
                        <div class="f13 info">请上传营业执照扫描件，证件信息必须清晰可辨识，支持jpeg、png、jpg格式，大小不超过2.5M。</div>
                        <div id="demoText"></div>
                        <div class="layui-upload"><button type="button" class="layui-btn layui-btn-normal mt20" id="bussiness_img"><i class="layui-icon">&#xe64a;</i> 上传图片</button></div>
                        <input type="hidden" id="bussiness_img_result" value=""/>
                </div>
        </div>

        <div class="layui-form-item">
                <h3 class="info-title">联系人信息<span class="f12 info ml30">联系人信息将作为公司认证审核时的重要参考，我们会对您的个人隐私类信息进行保密。</span></h3>
        </div>

        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 联系人姓名：</label>
                <div class="layui-input-block" style="width: 190px;">
                    <input type="text" name="liaison" id="liaison" autocomplete="off" class="layui-input">						
                </div>
                <p class="info mt f13 block ml100 pl80">请填写有效身份证件上的姓名，审核通过后不可修改。</p>
        </div>

        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 联系人证件号码：</label>
                <div class="layui-input-inline">
                        <select name="liaison_id_type" id="liaison_id_type" lay-verify="required">
                                <option value="1">身份证</option>
                                <option value="2">护照</option>
                                <option value="3">港澳通行证</option>
                                <option value="4">军官证</option>
                        </select>
                </div>
                <div class="layui-input-inline" style="width: 260px;">
                    <input type="text" name="liaison_id_no" id="liaison_id_no" autocomplete="off" class="layui-input">
                </div>
        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 联系人职务：</label>
                <div class="layui-input-inline">
                    <input type="text" name="liaison_job" id="liaison_job" autocomplete="off" class="layui-input">
                </div>
        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 联系人手机号码：</label>
                <div class="layui-input-inline">
                    <input type="text" name="liaison_mobile" id="liaison_mobile" autocomplete="off" class="layui-input">
                </div>
        </div>
        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red"></span> 联系人邮箱：</label>
                <div class="layui-input-inline">
                        <input type="text" name="liaison_email" id="liaison_email" autocomplete="off" class="layui-input">
                </div>
        </div>
        <div class="layui-form-item">
                <h3 class="info-title">账号信息<span class="f12 info ml30">账号信息将在前台页面对用户呈现，为了更好地展示公司形象，建议您认真填写相关资料。</span></h3>
        </div>

        <div class="layui-form-item layui-form-text">
                <label class="layui-form-label"><span class="red">*</span> 公司简介：</label>
                <div class="layui-input-block">
                        <textarea name="shop_info" id="shop_info" placeholder="请输入内容" class="layui-textarea"></textarea>
                        <p class="f13 info mt10">500个字以内，要求内容完整通顺，无特殊符号。</p>
                </div>
        </div>

        <div class="layui-form-item">
                <label class="layui-form-label"><span class="red">*</span> 公司LOGO</label>					
                <div class="layui-input-inline">
                    <div class="layui-upload photo-bak" id="logo_img_preview">						  
                          公司LOGO
                        </div> 
                </div>

                <div class="layui-input-inline" style="width: 300px;">
                        <div class="f13 info">上传公司LOGO图片，请勿添加二维码；支持jpeg、png、jpg格式，大小不超过2.5M。</div>
                        <div class="layui-upload"><button type="button" class="layui-btn layui-btn-normal mt20" id="logo_img"><i class="layui-icon">&#xe64a;</i> 上传图片</button></div>
                        <input type="hidden" id="logo_img_result" value=""/>
                </div>
        </div>

        <div class="layui-form-item border-t">
                <div class="mt30 content">
                <input type="checkbox" name="agree" id="agree" title="同意" lay-skin="primary"><a href="" class="mt10 info">《融媒智投服务协议》</a>
                </div>
                <div class="text-c mt30">
                        <a href="/user/seller/request" class="layui-btn layui-btn-primary layui-btn-lg">上一步</a>
                        <span class="layui-btn layui-btn-lg  layui-btn-normal" lay-submit lay-filter="formDemo" id="apply-submit">提交申请</span>

                </div>
        </div>
    </form>
</div>